www.cyclamed.org

Annual Report 2014

MESSAGE FROM THE CHAIRMAN 4

CYCLAMED ACTION PLAN® 6• Operation • Collection tools

STUDIES 10• Barometric survey • Study of the total supply of household Unused Medicinal Drugs (UMD)• The IRSTEA study

COMMUNICATION 14• Communication with health professionals• Communication with public at large• Corporate communication• Available equipment

QUANTITATIVE RESULTS 22• The overall balance sheet• Energy recovery by region• Partner recovery units• Regional performance per capita• Growth of the packaging supply

REGULATIONS 27

FUTURE 27

AFFILIATED PHARMACEUTICAL COMPANIES 28

FINANCIAL RESULTS 29

AnnUAl REPORT 2014COnTEnTS

MESSAGE fROM ThE ChAIRMAn

We have decided to present our results to you in a different way: traditionally we used to present you with the tonnage used to produce energy including the weight of Cyclamed cartons and also that of products other than Unused Medicinal Drugs (UMD) that we come across when doing our collection from the pharmacy. This year, we will refer to the quantities of Unused Medicinal Drugs (UMD) which are making progress and to our collection percentage compared to our total supply, which is also progressing and has reached 63%.

Among the events of note in 2014 that I want to mention we find:

• The development, with the wholesalers, of a new container to improve safety for the men and women who handle our cartons,

“The aims of CYCLAMED”

• The partnership with harmonie Mutuelle, the leading health mutual in france, in order to reach a greater number of stakeholders,

• The Effervescence conference in Montpellier, on the presence of medicinal residues in the water, which Cyclamed attended with a poster presentation and a round table discussion,

• The audit of our eco-organisation by the Cour des Comptes (Court of Auditors).

In particular I wish to thank all those

manufacturers of medi-cations who finance our

eco-organisation and who accepted a substantial

reassessment of their contributions for 2015 and 2016 in order to ensure the optimal safety of the retail pharmacists and delivery drivers via a new container which includes particular characteristics in terms of resistance to piercing and to moisture thanks to its plastic lining. finally, I would like once

again to thank our small team of three permanent staff members: Daniel ROBIn our director, Bénédicte nIERAT our communications manager and nathalie BOnnET our administrative assistant, who together manage Cyclamed on a daily basis with dedication and professionalism and who have been particularly involved in the audit by the Cour des Comptes and the construction of the new container.2014 must not make us forget about the future prospects for Cyclamed.

Therefore 2015 will be the year:• of preparation for our approval renewal which will enable us to continue with our efforts to make our eco-organisation even more efficient,

• when the audit carried out by the Cour des Comptes will be published and which should also be considered as a source of inspiration for the future,

• of the start of our operations in Mayotte, the last of the french Overseas Departments (fOD = DOM= Département

d’Outre Mer in french) that we did not cover and which should ensure that we do not forget our role vis-à-vis all of the territories wherever they may be,

• when our new container starts to be used

• when we work even harder to create a Cyclamed which is even more efficient with competitive costs, as our funders would like.

Cyclamed, which is the smallest eco-organisation in terms of products, staffing and communication expenditure, intends to assert its expertise and to anticipate new developments in the future.

We are counting on your support.

Thierry MOREAU DEFARGESChairman

Dear friends,

Thanks to you, Cyclamed has experienced another year of growth in its collection of unused medicinal drugs (UMD = MNU = Médicaments Non Utilisés in French).

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The association, which is approved by the public authorities, is tasked with collecting and processing unused medicinal drugs (Unused Medicinal Drugs (UMD) intended for human use, whether out of date or not, which have been returned to pharmacies by patients. Under the terms of the agreement concluded with the company Adelphe (a subsidiary of Eco-Emballages), empty packaging for medicinal drugs is sent for separate sorting.All French pharmacies are obliged to recover household Unused Medicinal Drugs (UMD) (law no.2007-248, published in the Official Journal on 27 February 2007). Patients should bring back their Unused Medicinal Drugs (UMD) after their treatment, and following verification of the content by the pharmacy team, these UMD are placed in Cyclamed cartons.In the course of their daily rounds the wholesalers collect the full cartons and deposit them in wast skips located at their premises. Once full, these waste skips are transported by carriers to energy recovery units within the Cyclamed partner community. A waste tracking slip is issued and completed by the wholesaler, the carrier and the incinerator which therefore includes the tonnage of the Unused Medicinal Drugs (UMD) recovered.Incineration of the Unused Medicinal Drugs (UMD) is the solution that best meets the environmental and public health requirements bearing in mind the nature of the products to be dealt with. It is also required of us in our specification. The 55 units provided and distributed in each of the regions comply with environmental standards and allow energy recovery in the form of heat and/or electricity.Pharmaceutical companies finance all the costs related to the operation of the strategy through their contributions to Cyclamed, which are calculated based on the number of boxes of medicinal drugs placed on the market.An Adelphe-Cyclamed-leem tripartite agreement was signed to ensure exchange of information in order to enable producers of medicinal drugs to contribute to each organisation in proportion to the packaging they collect.

In addition, these three organisations have come together to develop a common signage, “Info-tri Médicaments” (Info for Sorting Medicinal Drugs). This signage, in the form of pictograms which can be displayed on information notices, informs the patient/consumer that the Unused Medicinal Drugs (UMD) should be brought back to the pharmacy and that the empty packaging should either be placed in the recycling bin (e.g. cardboard) or discarded with household waste (e.g. blister pack).A Steering Committee meets every month to monitor the activities of the association through its management, its results and its communications. In addition, a Study and Information Commission meets every two months to update the members of the Board and to consider possible new directions.The association is administered by a Board elected for 3 years by the General Assembly and eligible for re-election, and includes representatives of the active members:the pharmaceutical companies operating on french territory in the domain of specialised pharmaceutical products for households and qualified persons representing the stakeholder bodies (lEEM, nOSC, SRfC, APR, fSPf, UnPf, USPO).In 2014 two meetings of the Board of Directors took place on 27 May and 19 november and two General Meetings were held on 12 June and 10 December with the main decisions taken being: the approval of the 2013 accounts and the setting of the scale for 2015.The permanent staff members, numbering three, were represented by a pharmacist-director, a communications manager and an administrative and accounting assistant.follow-up on the information requested in the specification of our approval was scrupulously adhered to (scale and amount of contributions, national and regional quantitative review, communication activities for professionals and the public at large, partner energy recovery units, affiliates, etc.).A procedure for monitoring the quality of the strategy has been in place since 2010 with a monitoring checklist which is triggered when any anomaly is detected at any level whatsoever. Thus, 23 action plans were established during 2014, eight of which related to accidents involving needle-stick injuries DASRI (Infectious Medical Waste), twelve others showed the presence of infectious medical waste but without causing injury and three others related to the presence of chemicals or poorly assembled cartons. none of these accidents had serious consequences for the drivers concerned.These accidents have led us to develop a new container along with the wholesalers.

CYCLAMED ACTION PLAN®

OPERATION

CYCLAMED is a non-profit organisation under the law of 1901 which groups together the whole pharmaceutical profession: retail pharmacists, wholesalers and pharmaceutical companies.

The operating principle

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HouseholdsSelective waste sorting

Pharmacies

Wholesalers

Energy recovery units

Manufacturers

Communities

UMD (Unused Medicinal Drugs)

fInAnCIAl flOWS

EMPTY PACKAGInG

COLLECTION TOOLS

CYCLAMED ACTION PLAN®

THE LATEST FIGURES 2014

These tools are available free of charge by electronic transfer or by oral request for each pharmacy with all wholesalers who provide delivery.

Cartons: 1,796,600 units were used in 2014 by french pharmacies and handled by wholesalers. This Cyclamed carton made of recycled material appeared for the first time in October 2013.for 2014, the average weight of the Cyclamed carton was 8.6 kg, significantly lower than previously, in line with the wishes of all involved in the strategy.Starting three years ago, new signage was put on the cartons indicating that no infectious medical waste, even in containers, should be placed in the carton and a communication exercise in this regard was carried out in 2014 through retail pharmacists and individuals by:✓ sending posters and leaflets,✓ reminders on our website.

But the interlocking of the flaps to close the base was shown to be fragile when the carton was placed on a damp floor or when vials or syrup containers that were not closed properly leaked. Therefore some cartons opened at the bottom, spilling their contents on the road and the drivers would try to catch these or pick them up, sometimes injuring themselves in the process. Therefore, it was decided to take a new approach with a new specification and to design a new model for 2015 with a reinforced automatic base with a bag attached to the four internal sides of the carton.

“Cyclamed” adhesive tape: more than 40,000 units each 100m in length were used in 2014 by pharmacy teams to address the problem referred to above and so avoid any risk of the carton opening unexpectedly.

CYCLAMED CYCLAMED

22,500

1,800,000

186

192

pharmacies involved in the recovery of unused medicinal drugs (UMD) returned by french households.

cartons filled with Unused Medicinal Drugs (UMD) by the pharmacy teams with an average weight of 8.6 kg.

distribution facilities dealing with the storage of full cartons.

affiliated pharmaceutical companies

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STUDIES

Three surveys are carried out on a regular basis to enable us to: - monitor on an annual basis the image, the reputation and the changes in the behaviour of our fellow citizens in relation to the sorting and return of UMD to pharmacies,- assess every two years the quantity of UMD in french households, - identify the nature of the waste collected and disposed of by the strategy.

BAROMETRIC SURVEY

This study, which was carried out by BVA, was conducted on 14 and 15 february 2014, a fortnight after our television campaign. It was conducted using telephone interviews with a sample of 1,015 people aged 18 years and over, the sample being representative of the french population in terms of gender, age and the profession of the head of the household.

The main findings were as follows:

Rates for the sorting of waste for all products or materials increased from 2011 to 2014, the increase probably being

linked to the significant media presence of all the eco-organisations.

More than three-quarters of french people stated that they returned their UMD to their pharmacies and 70% of those

“always” did so and 17% “often” did so.

Those who sorted waste were mainly senior citizens (80%) and households without children under 15 years of age (73%).In 89% of cases, waste sorting occurred at a given time and not at the end of treatment.More than a third of people who brought back their Unused Medicinal Drugs (UMD) to the pharmacist did so to ensure health safety in the home. More than a quarter did it to protect the environment.The main reasons for returning them to the pharmacy were the expiry date of the medicines for almost half of those who returned their Unused Medicinal Drugs (UMD), followed by the end of treatment for nearly one-third.

Unprompted awareness of Cyclamed reached 15% (16% taking into account pharmacists) and rose to 26% among people aged

35-49 years.

Prompted awareness (after mentioning the Cyclamed name) reached 62% and rose to 70% of women and 67%

for pensioners; it was characterised by knowledge mainly due to television (47%) and to pharmacists (31%) thanks to posters and window stickers.

The level of interest in the strategy remained high at 92% and has been stable since 2009.

The perception of the strategy is very positive for items related to the protection of the environment or health safety

in the home:✓for 93%: “it means that medicines don’t end up inland fill sites”.

✓for 92%: "it contributes to the protection of the environment”.

✓for 91%: "it avoids the risk of water pollution”.

✓for 88%: "it limits the risks of poisoning in the home”.

Out of all people surveyed or those who brought back their Unused Medicinal Drugs (UMD) to pharmacies only 6% in the

past year experienced a refusal on the part of a pharmacy to accept the UMD (this percentage rises to 11% in cities with 2, 000 to 100,000 inhabitants).

Around eight out of ten people who returned their Unused Medicinal Drugs (UMD) always did so in the same pharmacy.

The new TV ad slogan “Medicinal drugs are useful, let’s not make them harmful” was still not very well known among people

aware of Cyclamed. nevertheless it evokes positive responses in almost 9 out of 10 cases with notably the perception of ecological risk (17%) given more emphasis than the human risk (10%).

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7

8

9

2

3

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studies

THE STUDY OF THE TOTAL SUPPLY OF HOUSEHOLD UNUSED MEDICINAL DRUGS (UMD)

THE IRSTEA STUDY

Since 1996, at the request of ADEME (the Environment and Energy Management Agency), an annual study by the “Environmental Management and Biological Treatment of Waste” research unit of IRSTEA in Rennes has been carried out to characterise the waste collected under the action plan.

The latest study took place early in 2015. The sampling and sorting was carried out in waste skips located with three different wholesalers: the first in the nord/Pas-de-Calais, the second in Ile-de-france and the last in Brittany.

24 cartons were collected out of the 400 present in each waste skip, by a random drawing of lots.These 24 cartons were then down-sampled in such a way as to keep only one-eighth of each carton. Ultimately the sample consists of 3 cartons being representative of the full stock.

After the sample has been weighed, a first sort is done by separating the Unused Medicinal Drugs (UMD) from the other non-medicinal waste.

The Unused Medicinal Drugs (UMD) are then sorted into 12 categories: tablets, capsules, powders, syrups, solutions not taken orally, vials, aerosols, injectables, creams, suppositories, patches and totally empty packaging.

finally, the materials are sorted according to 4 components: cardboard (and paper), plastic, glass and metals.All the elements separated in this way are then weighed.

Categories 2014 study 2015 study

Unused Medicinal Drugs

Totally Empty Packaging

77.15%

9.50%

80.73%

5.43%

Packaging of medicinal drugs

Medicinal substances

45.31%

41.34%

46.02%

40.14%

Medicinal waste 86.65% 86.16%

Other Waste (non-medicinal) 13.35% 13.84%

First carried out by the CSA Institute in 2010, this evaluation study of the total quantity of Unused Medicinal Drugs (UMD) in French households was repeated in 2012 and 2014. This allows Cyclamed to measure its performance and to monitor how its action plan is progessing.

The investigation is carried out in accordance with a well-established process which is always identical: ✓Making contact with those persons who have responsibility for managing the medicinal drugs in 500 households being representative of the french population.✓An initial visit to win trust and to explain the purpose of the approach, including gathering together all the medicinal drugs in the home, not forgetting those that are kept in various places such as the office, the car, etc.✓A second visit in order to weigh all the medicinal drugs, including the Unused Medicinal Drugs (UMD).

So between 2010 and 2014, the quantity of Unused Medicinal Drugs (UMD) went from 23,500 tonnes to 19,200 tonnes, representing a decrease of 18%. Among the factors explaining this decrease are:✓The reduction in the consumption of medications,✓The reduction in prescriptions,✓The campaigns for the proper use of medications run by the authorities and by health professionals to make patients more aware of the importance of adhering to their course of treatment.

2010 2012Change since 2010

2014Change since 2012

Quantity per household(at a given moment in time) 477g 439g - 8% 358g -18%

Quantity French population(Quantity per household x number

of french households)

12,734 T**

2006 census

11,972 T** -6%

2008 census

9,945 T ** -17%

2010 census

Annual quantity French population(Quantity french population

x frequency of “destocking”***)

23,500 T*

2006 census

23,300 T* -<1%

2008 census

19,200 T* -18%

2010 census

* 1 household = 2.27 persons on average in 2010 (source:) Insee)** Source Insee - Census of the French population: 2006 - 26,696 thousand households / 2008 - 27,270 thousand house-holds / 2010 - 27,786 thousand households*** Frequency of "destocking" calculated based on the question “more specifically, during 2013 how many times did you carry out this sorting?''

Extrapolating this to all french households taking into account the frequency of destocking (an average of twice per year), gives the total quantity of Unused Medicinal Drugs (UMD) according to the table below:

The following table gives the results of the 2015 study compared to that of 2014.

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The table shows a marked decrease (43%) in totally empty packaging and a continuing level of between 13 and 14% for non-medicinal waste mainly consisting of parapharmacy products.

Information update and newsletter✓ In 2014 an edition was produced with 26,000 copies distributed to all of our partners, including retail pharmacists, wholesale distributors, pharmaceutical companies, the authorities, patient and consumer associations and the press. It was accompanied by the window sticker campaign and by the product poster “What should I bring back? "and the poster aimed at the pharmacy team to provide a disposal solution for each patient health product. This newsletter set out our quantitative results compared with 2013/2012, indicated the main elements to take from the barometric survey, noted our public at large communications through our TV campaign, our website and via social networks and referred to the significant decline of 18% in our stock of Unused Medicinal Drugs (UMD) between 2012 and 2014.

✓ In June, the first newsletter to be sent by email to all pharmacies appeared on World Environment Day. It focused on safety in collections with good practices, particularly in relation to avoiding syringes and needles in the Cyclamed process.

Regional meetings A “Tour de france” went around the regional capitals in order to publicise the quantitative and qualitative results and Cyclamed’s communication activities. With one meeting taking place each month and run by the association’s management, they were held in two parts:✓The first concerned the different parties involved in the strategy at a regional level: Chamber and pharmacist trade unions, wholesalers, Regional health Authorities, Ademe, handlers, recovery units and consumers or patient associations.✓With the aid of the regional media (press, radio and television) the second part helps to increase awareness among consumers and to re-engage them with the “Think Cyclamed” concept. Media spin-offs are always important and automatic in the printed media, local radio and sometimes in regional television.

Visits to distribution facilitiesSince September 2010 the Director of Cyclamed has been meeting managers of distribution facilities (director, operations manager, pharmacist, driver manager) in order to take stock of the strategy in the facility and to make available the necessary documentation for it to function properly.In 2014, fifteen establishments were visited in Aquitaine, Burgundy and in the PACA region.Several topics were reviewed, namely:✓The accessibility of Cyclamed products.✓Maintaining a sufficient supply of cartons.✓Accepted or rejected products.✓Customisation of cartons. ✓The timescale for recovery of full cartons.✓Accidents in the course of the activities (infectious medical waste, chemical products).✓The maintenance and storage of the waste skip for the stocking of cartons.✓The relationship with the waste carriers.✓Monitoring of the waste skip with the withdrawal dockets.

The main themes discussed in these meetings include:

COMMUNICATION WITH HEALT PROFESSIONALS

COMMUnICATIOnThe communication activities within the profession, in relation to institutions and for the public at large are intrinsic to extending the concept of “Think Cyclamed” to as many of our fellow citizens as possible.

regional meetings

Paris

Poitiers

Orléans

Bordeaux

Rouen

For 2014, the schedule was as follows:

Rouen, 13 JanuaryBordeaux, 10 FebruaryDijon, 11 MarchParis, 3 April Orléans, 13 MayReims, 2 JuneMarseille, 30 JuneMontpellier, 8 SeptemberBastia and Ajaccio, 6 and 7 OctoberLille, 3 NovemberPoitiers, 8 December

Sorting of the Unused Medicinal Drugs (UMD)

in the pharmacy and rejected products.

Waste from veterinary medicinal drugs.

Identification of Cyclamed cartons.

Drugs

The disposal of chemical pharmaceutical products.

Professional and public communication

Infectious medical waste and the establishment

of the new eco-organisation, DASTRI

(Infectious Medical Waste), from June.

Qualitative studies carried out by BVA and CSA.

Dijon

Bastia

Ajaccio

MarseilleMontpellier

Reims

Lille

Chers confrères, chers amis,

Une nouvelle lettre Cyclamed, pourquoi ?

Nos résultats de récolte sont bons, grâce à vous tous. Mais nous avons des efforts à faire pour sécuriser notre dispositif aussi bien à l’officine que pour les grossistes répartiteurs.

Des événements ces derniers mois nous ont conduits à faire évoluer fin 2013 notre contenant en

diminuant sa taille, en renforçant la qualité du carton et en y adjoignant des poignées. Cela ne suffit pas, nous devons aussi nous mobilier, tous, sur nos actes au quotidien :

- Mieux informer les patients sur la définition du MNU Une nouvelle affiche vous est donc proposée ci-joint.- Mieux s’assurer du contenu des sacs de retour en questionnant le patient sur l’absence de DASRI dans le sac de MNU retourné .- Donner les moyens à l’équipe officinale et aux patients pour orienter vers les bonnes filières de prise en charge des déchets médicaux au sens large.- Former et informer nos personnels respectifs à des règles de sécurité à appliquer ou à mettre en place pour une plus grande sécurité (port de gants par exemple).

Avec les syndicats officinaux, la Chambre Syndicale de la Répartition Pharmaceutique, l’Ordre des Pharmaciens et les Industriels (tous au sein de notre conseil d’administration ou du groupe de concertation, information et réflexion), nous avons créé 3 nouveaux documents :

- Une nouvelle affiche « Que rapporter ».- Une nouvelle affiche destinée à l’équipe officinale pour orienter vers les bonnes filières de tri et d’élimination des déchets.- Un feuillet informatif pour le patient qui sert de support pour une opération test en communication pour les pharmacies de trois régions: PACA, Aquitaine et Pays de la Loire.

Ces documents sont également téléchargeables sur notre site : www.cyclamed.org

Merci à chacun d’en assurer une large diffusion et exposition, afin que le geste sécurité devienne un réflexe.

Thierry MOREAU DEFARGESPrésident de Cyclamed

la lettreN°44 - mai 2014

chiff

res

Résultats quantitatif 2013

UNE CROISSANCE DE LA COLLECTE DES MNU EN 2013, ALORS QUE LE NOMBRE DE MEDICAMENTS NON UTILISES BAISSE DANS LES FOYERS FRANÇAIS.

En progression de 3,2 % en 2013 par rapport à 2012, la collecte des Médicaments Non Utilisés (MNU) atteint 14 730 tonnes , alors que le nombre de boîtes de médicaments vendu en pharmacie est en baisse. Cette évolution s’explique principalement par le lancement de deux nouveaux spots TV avec un plan média mobilisant plus particulièrement les mères de familles. La fidélisation des consommateurs à ce geste éco-citoyen et la dynamique plus grande du tri sélectif des déchets en général expliquent également cette performance.

La valorisation énergétique de ces MNU est réalisée dans 53 unités de valorisation partenaires pour éliminer dans le respect de l’environnement et récupérer l’énergie sous forme de chaleur et/ou d’électricité.

édito

rial

ISSN : 1964 471X

358 GRAMMESDE MNU PAR FOYER

Une CROISSANCE de la collecte des MNU en 2013...

Des Français concernés

... alors que le nombre de MNU BAISSE

2010

2012

2013

SOIT

+3,2INFOGRAPHIE

358 gr

439 gr

477 gr

77% des Français déclarent rapporter leurs MNUen officine

358gr

DE MOINSQU’EN 2012

14 730 tonnes en 201314 271 tonnes en 2012VS

18%

Sour

ce :

étud

e BV

A 20

14 Source : étude CSA 2014

www.cyclamed.orgLes médicaments sont utiles, ne les rendons pas nuisibles

dans les foyers français.

LA COLLECTE DES MÉDICAMENTS NON UTILISÉS (MNU)CYCLAMED - LES CHIFFRES CLÉS

%

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COMMUnICATIOnCOMMUNICATION WITH PUBLIC AT LARGE

“Medicinal drugs are useful, let’s not make them harmful”

These two ads, each 12 seconds long, were broadcast extensively in 2014 on Tf1 and M6 aimed at mothers and also naturally had implications for senior citizens. The various TV campaigns took place:

from 13 January to 2 February

The televised campaignConsidered to be a campaign of general interest, it allows us to be an off-screen advertiser and to benefit from preferential rates.In January 2013, the association established two new TV ads:

one concerns the protection of the environment because medicinal drugs contain active chemical molecules that can be potentially dangerous for our environment if they are thrown into the toilet or put into the natural surroundings (landfill, etc).the other concerns domestic health safety because storing Unused Medicinal Drugs (UMD) for too long at home may lead to the risk of mixing up medications for senior citizens and of poisoning by ingestion for children.

This campaign is aimed at increasing the motivation of french citizens to return their Unused Medicinal Drugs (UMD) to the pharmacy. Indeed, as soon as there is any medicinal drug left over, even if it is only a tablet, it should be returned in its packaging to the pharmacist. On the other hand, any empty medication packaging should be directed towards the system for recycling of packaging put in place by the local commune. These ads have a new style, with 3D characters representing unused medicinal drugs in tablet and capsule form on packaging for a medicinal drug. They call for and encourage their return to the pharmacy, and the ad finishes with:

•

•

The website (www.cyclamed.org)Our site is certified with the hOn (health On the net) label and has received international recognition for the health information provided. During 2014 the site was reorganised to make navigation easier. Accordingly, on the home page there is more direct access to basic and practical information for the public at large and to the areas dedicated to professionals.On average there were 5,500 visits per month in 2014 and the average browsing time was 3 minutes. Some 850 requests to be contacted by email were made, including 42% by individuals and 33% by health professionals.In the event of a reported rejection the information is automatically transmitted to the Chamber and to the pharmacy trade unions. furthermore, a procedure has been put in place with an email being sent containing the contact details of the pharmacy concerned to the Conseil national de l’Ordre des Pharmaciens (national Chamber of Pharmacists) which then relays the information to the President of the Regional Chamber, which in turn deals with it at a local level with the pharmacy.The most frequently visited pages include the information from the home page, products collected, frequently asked questions and the organisation of the strategy.lastly, during 2014 key words were enriched and integrated to expand our natural referencing, including: “sorting of medicinal drugs”; “domestic accidents with medicinal drugs”; “what to do with out-of-date medicinal drugs”; “tidy up one’s pharmacy”; “water pollution by medicinal drugs”.

In relation to social spaces, the Facebook community has exceeded 6,000 fans, the Twitter account has gained momentum and the views on Slideshare have tripled.

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from 14 Aprilto 27 April

from 14 July to 3 August

✓On 4 December 2014, Cyclamed signed a partnership agreement with harmonie Mutuelle, the leading health mutual in france. Severa reciprocal commitments were agreed including:

- Making the public at large and health professionals more aware of the importance of adhering to prescribed treatments,- A greater degree of responsibility in the management of waste from health products.

✓A partnership was also signed with the Compagnie des Aidants, a secure online social network aimed at helping people made vulnerable by illness, disability and/or old age. Information and videos have therefore been put in place on the respective websites.

✓The “Info for Sorting Medicinal Drugs” user guide aimed at pharmaceutical companies was produced by Adelphe in partnership with Cyclamed and lEEM. This signage, in the form of pictograms put on medicinal drug notices or boxes, provides assistance to patients for sorting their products.In 2014, 11% of pharmaceutical companies were involved with this approach.

✓A new partnership was agreed with Second Stage Pharma. 7,000 general practitioners and gynaecologists have been approached about putting Cyclamed posters and cartoons in their waiting rooms to increase awareness among their patients.

✓A partnership was established with the agency UNIVISION to broadcast our two TV ads free of charge in the waiting rooms of general practitioners and specialists inToulouse and Marseille.

✓On 13 May Cyclamed took part in the ORDIf forum (Ile-de-france Region Waste Management Observatory) where local authority communication managers were able to learn about the strategy.

✓On 25-26 and 27 november, the association participated in the Salon des Maires and shared a stand with five other eco organisations: COREPIlE – DASTRI – Eco-TlC – ERP – SCRElEC in order to increase awareness in local authorities about providing information on the return of UMD to pharmacies.

✓Cyclamed participated in various working groups with ADEME to produce a "Toolbox" and a website, in order to provide good instructions about sorting to local authorities and their constituents.

✓The association gave a presentation on its action plan and its results to students in the faculty of Pharmacy in Strasbourg and participated in the Colloque Effervescencein Montpellier, on the issue of medicinal drug residues in aquatic environments, on 20 and 21 november with participation at a round-table on the proper use of medicinal drugs.

Poster of accepted and rejected productsThe main purpose of this A3 poster, which was redesigned in 2014 and which is intended to be displayed in pharmacies, is to increase awareness among retail pharmacists so that only Unused Medicinal Drugs (UMD) for human use brought back from households is collected in Cyclamed cartons.A comment has been added at the bottom of the page on the subject of DASRI (infectious medical waste from patients who are self-medicating) to make it clear that syringes and needles, even in containers, are not to be included in the Cyclamed procedures under any circumstances.This poster has also been made available in A5 leaflet format with the accepted products on the front and the rejected DASRI products on the back.This poster and 100 leaflets were sent to all pharmacies in 2014.

Window stickers This medium, which is sent out periodically to pharmacists, is legible and visible both inside and outside the pharmacy once it is affixed to the shop window or the door.With the logo and the phrase "Bring back your unused medicinal drugs, it’s the natural thing to do" the window display is specifically a reminder to the public about returning Unused Medicinal Drugs (UMD) to the pharmacy.It is automatically sent every year to all pharmacies along with the newsletter.

LA GESTION DES MÉDICAMENTS NON UTILISÉS :

UN VÉRITABLE ENJEU DE SANTÉ PUBLIQUE

Harmonie Mutuelle, mutuelle soumise aux dispositions du livre II du Code de la mutualité, immatriculée au répertoire Sirene sous le numéro Siren 538 518 473. Siège social : 143, rue Blomet - 75015 Paris. DirCom/Pôle communication digitale et MOA/Réalisation Agence interne de communication - 11/14.

WWW

www.harmonie-mutuelle.fr www.cyclamed.org

Pour en savoir plus...

LES MÉDICAMENTS SONT UTILES

NE LES RENDONS PAS NUISIBLES

Harmonie Mutuelle et Cyclamed s’engagent ensemble pour préserver l’environnement

et favoriser le bon usage du médicament.

Les médicaments de votre armoire à pharmacie

MISE À LA POUBELLE

POLLUTIONENVIRONNEMENTALE

Sols et eaux souterraines

DÉCHARGE

INGESTION ACCIDENTELLE

PAR UN ENFANT,UNE PERSONNE

ÂGÉE...

ACCIDENT DOMESTIQUE

RISQUE

2RISQUE

1

Flacons de sirop, solutions, ampoules buvables ou injectables…

Aérosols, sprays, inhalateurs…

Comprimés, gélules, poudres…

Pommades, crèmes, gels…

Suppositoires, patchs, ovules…

Les boîtes à aiguilles distribuées par votre pharmacien sont collectées séparément.

Renseignez-vous auprès de votre pharmacien.

À RAPPORTER

RAPPORTEZ À VOTRE PHARMACIENVOS MÉDICAMENTS NON UTILISÉS, PÉRIMÉS OU NON, MÊME ENTAMÉS.

DE LA COLLECTE

À LA VALORISATION DES MÉDICAMENTS

Adopter le réflexe Cyclamed, c’est réduire

2 SOURCES DE RISQUES liés à l’usage domestique :

70 % DES MÉDICAMENTS

NON UTILISÉS

COLLECTÉSDANS LES PHARMACIES EN 2013

14 730 TONNES COLLECTÉESDANS LES PHARMACIES EN 2013

SOURCE : ADEME (AGENCE DE L’ENVIRONNEMENT ET DE LA MAÎTRISE DE L’ÉNERGIE)

1g 1g 1g

100 g 100 g 100 g50 g

5g

GISEMENT DE

358 GRAMMES

DE MNU* PAR FOYER FRANÇAIS EN 2014 EN MOYENNE

COLLECTE DE

225 GRAMMES

DE MNU* PAR FOYER FRANÇAIS EN 2013 EN MOYENNE

SOURCE : INSTITUT CSA ÉTUDE 2014

Ensemble,rapportons les Médicaments Non Utilisés dans les pharmacies.

100 g 100 g

25g

* MNU : Médicaments Non Utilisés

COMMUnICATIOnCORPORATE COMMUNICATION

MATERIALS AVAILABLE

18 19

QUANTITATIVE RESULTS

The poster for the retail pharmacy team It is sent every year to all pharmacies along with the newsletter, the window sticker and the "What should I bring back?" poster - this poster is designed to help members of the pharmacy team to answer questions from patients about the elimination of the various health products other than Unused Medicinal Drugs (UMD) such as, for example, parapharmacy products, food supplements, x-ray images or diagnostic equipment.

The Quality & Safety Charter and the Quality Monitoring Checklist (FOQ) Developed and distributed for the first time in 2010, these two tools set out the commitments of the major participants in the strategy (pharmacies - wholesalers - manufacturers - Cyclamed). The Quality Monitoring Checklist ensures that any malfunction in the strategy can be analysed and traced by the Cyclamed management, mainly in relation to pharmacies and wholesalers. The Charter was reviewed in 2013 when it was presented.These documents are distributed on a regular basis to participants in meetings in the regions and are available on the website.

COMMUnICATIOnMATERIALS AVAILABLE

20 21

QUAnTITATIVE RESUlTSTHE OVERALL BALANCE SHEET ENERGY RECOVERY BY REGION

for 2014, the Cyclamed association decided to carry out a detailed analysis of the amounts collected in order to accurately measure its performance.15,465 tonnes of waste were collected by french pharmacies and aggregated by the wholesalers before energy recovery, or an increase of 5% compared to 2013. To assess the actual tonnage of Unused Medicinal Drugs (UMD) collected, two elements have been subtracted:- the tonnage of the Cyclamed cartons containing the Unused Medicinal Drugs (UMD), or 1,608 tonnes,- the tonnage of other waste (essentially parapharmacy products), or 1,801 tonnes.Therefore, the actual tonnage of Unused Medicinal Drugs (UMD) collected in 2014 was 12,056 tonnes, or an increase of 1.7% compared to 2013.

By comparing the tonnage of Unused Medicinal Drugs (UMD) collected, i.e. 12,056 tonnes, with the supply of UMD assessed by the CSA study, i.e. 19,200 tonnes, we arrive at a performance rate of 63%.

The collection of Unused Medicinal Drugs (UMD) increased by 1.7% in 2014 compared to 2013. This increase can primarily be mainly explained by:✓a greater involvement of citizens and pharmacists,✓a greater consumer adherence to the concept of returning UMD to the pharmacy,✓a greater dynamic among french citizens in relation to the selective sorting of waste in general,✓a TV media plan aimed primarily at mobilising mothers.

2012 2013 2014Change

2014 / 2013 (%)

Total assessed tonnage (t) 14,271 14,730 15,465 5.0

UMD tonnage (t) 11,309 11,849 12,056 1.7

Total quantity 23,300 19,200 19,200 - 18

Performance 49% 62 % 63 %

REGION 2013 (in tonnes) 2014 (in tonnes) Growth (%) Auvergne 252 266 +6

PACA 923 971 +5

Aquitaine 596 619 +4

Limousin 238 247 +4

Basse-Normandie 281 291 +4

Pays-de-la-Loire 706 731 +4

Rhône-Alpes 1,034 1,065 +3

Midi-Pyrénées 554 569 +3

Haute-Normandie 385 395 +3

Bretagne 607 622 +3

Ile-de-France 1,643 1,681 +2

Centre 502 509 +1

Picardie 469 474 +1

Bourgogne 374 378 +1

Nord/Pas-de-Calais 848 857 +1

Franche-Comté 214 215 0

Languedoc-Roussillon 512 514 0

Lorraine 479 479 0

Alsace 348 346 -1

Champagne-Ardenne 309 302 -2

Poitou-Charentes 392 368 -6

Corse 37 34 -8

D.O.M 145 123 -15

TOTAL 11,849 12,056 +1.7

22 23

15,465 tof waste used for energy recovery

12,056 tof Unused Medicinal

Drugs (UMD) collected and properly

disposed of

63%performance rating

55energy recovery units

7,000dwellings heated

and/or lighted each year

The equivalent of approximately

QUAnTITATIVE RESUlTSPARTNER RECOVERY UNITS

REGION CITY PARTNER

ALSACE ColmarStrasbourg

S.C.C.U.C.U.S.

AQUITAINEAgen

BèglesCenon

SOGADASTRIA

SOCOGEST

AUVERGNE BayetClermont-ferrand

ROnAVAlVERnEA

BOURGOGNE Dijonnevers

GRAnD DIJOnSOnIRVAl

BRETAGNE

CarhaixBrest

Briec / OdetDinan

Rennes

nOVERGIESOTRAVAl

GEVAlIDEx fASSA EnVIROnnEMEnT

SOBREC

CENTREBlois

ChartresSaran

ARCAnTEORISAnE

S.n.C. ORVADE

CHAMPAGNE-ARDENNE ReimsChaumont

REMIVAlShMVD

FRANCHE-COMTEBesançon

Montbéliardlons le Saunier

SYBERTCAPM

SYDOM

LANGUEDOC-ROUSSILLONnîmes

lunel VielPerpignan

EVOlIAOCREAlCYDEl

LIMOUSIN Brive limoges

I.n.O.R.S.T.V.l.

LORRAINE RambervillersTronville en Barrois

S.O.V.V.A.D.MEUSE EnERGIE

MIDI-PYRENEES Toulouse SETMI

NORD / PAS-DE-CALAISSt Saulve BéthuneDouchy

CIDEME SEMIORA

S.G.T.D.BASSE-NORMANDIE Caen SIRAC

HAUTE-NORMANDIERouen

le havreEvreux

SMEDAROREADEECOVAl

ILE DE FRANCE

Carrières sous Poissy CréteillagnyPlaisir

Vaux le Pénil

AZAlYS nOVERGIEnOVERGIE

C.n.I.M.GEnERIS

PAYS DE LA LOIREle Mansnanteslasse

S.E.C.ARC En CIEl

SAVEDPICARDIE Villers St Paul ESIAnE

POITOU-CHARENTES la RochellePoitiers

SETRADSETRAD

PACA AvignonToulon

nOVERGIEC.C.U.A.T.

RHONE-ALPESAnnecy

Grenoble lyon

Villefranche s/Saône

SIlAAThAnORlYOn SUD

SYTRAIVAlDOM fort de france MARTInIQUAISE DE VAlORISATIOn

for Cyclamed, in 2014, 55 energy recovery units were utilised, or two more than in 2013 with the Brest and Clermont-ferrand units. These 55 units cover the whole of france and have been chosen based on their geographical closeness to the waste skips at wholesalers. They all conform to environmental standards and recover the energy released in the form of steam (for heating homes) or in the form of electricity (to light homes).

24 25

REGIONAL PERFORMANCE PER CAPITAREGION Population (thou-

sands) Quantity (tonnes) Reusable Weight(in g./per capita.)

Limousin 741 247 333

Picardie 1,925 474 246

Bourgogne 1,644 378 230

Champagne-Ardenne 1,333 302 227

Haute-Normandie 1,848 395 214

Nord/Pas-de-Calais 4,052 857 212

Poitou-Charentes 1,792 368 205

Lorraine 2,351 479 204

Pays de la Loire 3,658 731 200

Centre 2,573 509 198

Basse-Normandie 1,479 291 197

PACA 4,937 971 197

Auvergne 1,356 266 196

Midi-Pyrénées 2,947 569 193

Bretagne 3,260 622 191

Languedoc-Roussillon 2,727 514 189

Aquitaine 3,303 619 187

Alsace 1,861 346 186

Franche-Comté 1,178 215 183

Rhône-Alpes 6,393 1,065 167

Ile de France 11,978 1,681 140

Corse 322 34 106

DOM 1,883 123 65

Total / Average 65,543 12,056 184

for 2014, the total assessment of Unused Medicinal Drugs (UMD) from french households was 12,056 tonnes, corresponding to 184 grams per resident. 9 regions exceeded 200 grams and one region exceeded the 300-gram threshold.

REGUlATIOnS

1. Obligation for retail pharmacists to collect Unused Medicinal Drugs (UMD): Article 32 of law no. 2007-248, published in the Official Journal of 27 february 2007, requires pharmacies to collect, free of charge, any Unused Medicinal Drugs (UMD) in their packaging and whether out-of-date or not, which are returned by individuals

2. End of humanitarian redistribution:In accordance with the statutory provisions, the humanitarian redistribution of Unused Medicinal Drugs (UMD) ceased on 31 December 2008 (article 8 law no. 2008-337 of 15 April 2008 ratifying ordinance no. 2007-613, 26 february 2007).

3. Approval for the collection of Unused Medicinal Drugs (UMD) packaging: The procedures for monitoring the activities for the elimination of the packaging waste in relation to medicinal drugs recovered by the association Cyclamed have been approved for a period of six years in the context of the implementation of decree no. 92-377 of 1 April 1992 concerning packaging waste (order of 3 March 2009, published in the Official Journal of 14 March 2009) and renewed for 1 year by the order of 10

March 2015 published in the Official Journal of 21 March 2015.

4. Obligation for pharmaceutical companies to take responsibility for Unused Medicinal Drugs (UMD):Any pharmaceutical company which works with medicinal drugs for human use in households must provide or contribute to the handling of Unused Medicinal Drugs (UMD) (decree no. 2009-718 of 17 June 2009, published in the Official Journal on 19 June 2009).

5. Approval of Cyclamed: The order approving Cyclamed for the collection and destruction of UMD for human use of 25 January 2010, in accordance with article R 4211-28 of the french Public health Code, was published with its specification in the Official Journal of 5 february 2010. This approval will apply for six years.

6. Appointment of the State Censor: In accordance with article l.54-10 of the Environmental Code and by decision of 27 May 2011, Madame Brigitte KlEIn has been named as State Censor in relation to the association Cyclamed.

fUTURE

26 27

2012 (in tonnes) % 2013 (in tonnes) %

Paper / Cardboard (without the notices) 25,562 35 24,922 35

Glass 20,035 28 17,662 25

Plastic 21,295 29 22,058 31

Aluminium + others 5,926 8 6,054 9

TOTAL 72,818 100 70,696 100

QUAnTITATIVE RESUlTSGROWTH OF THE PACKAGING SUPPLY

Since 2006 pharmaceutical companies have contributed to ADElPhE in relation to the packaging of medicinal drugs destined for households. Their declarations allow an assessment of the quantity of packaging for medicinal drugs, which has evolved between 2012 and 2013 as follows:

The quantity of packaging for medicinal drugs reduced by 3% between 2012 and 2013. This reduction is mainly linked to that of glass which fell by 12%.for 2014, as the number of boxes of medicinal drugs sold in pharmacies decreased by 1.2%, a total quantity of under 70,000 tonnes of packaging for medicinal drugs can be expected.

Several new actions will materialise in 2015:✓A new update to the Cyclamed carton designed to hold the UMD.✓A review of the quality of the content of the cartons focusing exclusively on the return of UMD in their single primary packaging with secondary packaging(cardboard boxes and notices) being directed towards selective sorting.✓Combining our approval in relation to packaging with our approval for UMD.✓The forthcoming implementation of the strategy in Mayotte.✓Working more closely with other eco-organisations for certain communication activities.

ABBOTT PRODUCTSABBVIEACCORD HEALTHCARE FRAnCEADDMEDICAAGUETTAnTALCOnALFA WASSERMAnn PHARMAALK ABELLOALLERGAn FRAnCEALMIRALL SASALMUS FRAnCEALTERAMGEnAPTALIS PHARMAARCHIMEDES PHARMA FRAnCEARKOPHARMAARROW GEnERIQUESASTELLAS PHARMAASTRAZEnECAAUVEXBAILLEUL-BIORGABAILLY-CREATBAXTERBAYER SAnTEBAYER SAnTE FAMILIALEBESInS InTERnATIOnALBIOCODEXBIODIMBIOGARAn SASBIOGEn FRAnCEBIOLUZBIOPROJET PHARMABOEHRInGER InGELHEIMBOIROnBOUCHARA-RECORDATIBRACCO IMAGIn FRAnCEBRAUn MEDICALBRIDEBRISTOL-MYERS SQUIBBC.A.G. PHARMAC.C.D.CEVIDRACHAIX & DU MARAIS-LAVOISIERCHAUVInCHIESICHUGAI PHARMA FRAnCECOOPER PHARMA. FRAnçAISECOSMéTIQUE ACTIVE FRAnCE LA ROCHE POSAYCRInEXCRISTERSCSL BEHRInGCSPDAIICHI SAnKYOD&A PHARMADB PHARMADELBERTDERMOPHIL InDIEnDEXODIETETIQUE ET SAnTEDISSOLVUROLDOLLIAGEEFFIKE.G. LABO EUROGEnERICSEISAIELERTEEREMPHARMAEUROPHTA

EUSA PHARMAEXPAnSCIEnCEFERRInGFRESEnIUS KABI FRAnCEGALDERMA InTERnATIOnALGALDERMA – Q – MEDGE HEALTHCAREGEnEVRIERGEnZYMEGERDAGIFRER BARBEZATGILBERTGILEADGLAXOSMITHKLInEGLAXOSMITHKLInE SAnTé GRAnD PUBLICGOMEnOL (DU)GRAnIOnS (DES)GRIMBERGGRUnEnTHALGUERBETHAC PHARMAH.R.A. PHARMA FRAnCEHEPATOUMHOMME DE FER (L’)HORUS PHARMAHOSPIRA FRAnCEInnOTECH InTERnATIOnALInnOTHERAInTERMUnEIPHYMIPRAD-VEGEBOMIPSEn PHARMAJAnSSEn-CILAGJOHnSOn & JOHnSOn SAnTé BEAUTéJOLLY JATELJUVISE PHARMACEUTICALSKREUSSLER PHARMAKRKALABCATALLAPHALLEHnInGLEO PHARMAGABRIEL LESOURDLEURQUIn MEDIOLAnUMLFB BIOMEDICAMEnTSLILLY FRAnCELISAPHARMLSH ET ROCALLUnDBECKMAJORELLEMAYOLY SPInDLERMEDA PHARMAMEnARInIMERCK SEROnOMERCK MéDICATIOn FAMILIALEMERCK SHARP & DOHME-CHIBRETMUnDIPHARMAMYLAnnEGMAnEPALMnEPEnTHESnOGUESnORDIC PHARMA SASnORGInE PHARMAnOVARTIS PHARMA

nOVARTIS SAnTé FAMILIALEnOVO nORDISK PHARMACEUTIQUEnUTERGIAOMEGA PHARMAOTSUKA PHARMACEUTICALPAnPHARMAPFIZERPFIZER SAnTé FAMILIALEPHARMA 2000PHARMA DEVELOPPEMEnTPHARMASERVICESPHARMASTRAPHARMY IIPIERRE FABRE DERMATOLOGIEPIERRE FABRE MEDICAMEnTPIOnnEAUPREDPROCTER & GAMBLEPROSTRAKAn PHARMAR&D PHARMARECKITT BEnCKISER HEALTHCARERICHARDROCHEROTTAPHARM MADAUSRPG RAnBAXYSAnDOZSAnOFI AVEnTISSAnOFI AVEnTIS – MSD PASTEURSERBS.E.R.PSERVIERSEVEnE PHARMASHIRESIGMA-TAU FRAnCESInCLAIR PHARMA FRAnCES.M.BSODIASOFIBELSOPHARMSTALLERGEnESSUnSTAR PHARMADEnTSUPER DIETTAKEDA FRAnCETECHnI-PHARMATEOFARMATEVA SAnTETHEATHERABEL LUCIEn PHARMATHERAMEXTOnIPHARMTRADIPHARUCB PHARMAURGO VEnIPHARMVIFOR FRAnCEVIIV HEALTHCAREVIROPHARMAWELEDAZAMBOnZYDUS FRAnCE

28 29

Contributions UMD and associated packaging 7,020,652.64 7,140,621.76

TOTAl PRODUCTS 7,020,652.64 7,140,621.76

Purchases 1,214,592.62 1,644,174.59

Cartons 1,140,565.06 1,596,391.27

Adhesives 74,027.56 47,783.32

Elimination 3,780,839.86 4,045,484.29

Incineration 1,627,345.49 1,734,609.06

Waste skip hire 341,778.89 342,081.60

Transportation of waste 1,326,868.24 1,414,691.99

Other Services 484,847.24 554,101.64

Studies 22,300.00 83,887.00

Communication 1,163,604.60 852,640.43

Public at large campaign 950,438.77 660,364.19

Internal Communication 51,545.22 43,965.23

Other Comm. Services 161,620.61 148,311.01

Operating costs 395,824.34 405,864.73

Staff 309,214.20 318,755.89

Premises 36,474.96 37,087.90

Various services 44,891.42 44,478.61

Taxes and duties 3,516.50 3,615.35

Depreciation 1,727.26 1,926.98

Provision for future expenses 443,491.22 108,570.72

TOTAl OPERATInG ExPEnSES 7,020,652.64 7,140,621.76

OPERATInG PROfIT 0.00 00.00

fInAnCIAl RESUlT 29,771.82 24,623.41

ACCOUnTInG RESUlT 29,771.82 24,623.41

TAxABlE InCOME 0.00 0.00

Contributions:They are obtained solely from pharmaceutical companies by applying €0.0022 excl. tax per box of medication. The rate of packaging associated with Unused Medicinal Drugs (UMD) compared to the total stock on the market is 8.29%.

Purchases:With a total of€1,644K they represent 23% of the total costs for the year. Cartons represent the largest item with 97% of the purchases.

Disposal:With a total of €4,045K the elimination of Unused Medicinal Drugs (UMD) andthe associated packaging represents 56% of the total costs for the year.The cost of disposal of one tonne of waste (incineration+rental+transportation) was € 226 in 2014, including €112 for incineration.

Communication:Expenditure totalled €852K or 12% of the total costs for the year. 77% of this was used for the public at large television campaign.

Operating Costs:These totalled €406K representing less than 6% of the total costs for the year.

Provision for future expenses:In accordance with the decree of 25 January 2010, the total of the contributions less the total of all expenses has been allocated as a provision towards future expenditure.At the end of 2014, these cumulative provi-sions totalled €552K.

Results verified by statutory auditors.

ExPEnSES

PRODUCTS financial year 2013

financial year 2014

StudiesThe total of €84 corresponds toqualitative and characterisation studies.

AffIlIATED PhARMACEUTICAl COMPAnIES 2014 fInAnCIAl RESUlTSTHE MAIN COMMENTS ON THE PROFIT AND LOSS ACCOUNT ARE AS FOLLOWS:

The involvement of medicinal drug professionalsretail pharmacists, wholesalers, manufacturers

in the recovery and processing of Unused Medicinal Drugs

86, rue Thiers - F. 92100 Boulogne-Billancourt - Tel.: 01 46 10 97 50www.cyclamed.org